Fertility Billing Services for Ancillary Lab Revenue
Fertility clinics are a cornerstone in the rapidly growing area of women’s health. Amid increasing operational costs, payer complexities, and patient expectations, many fertility practices are looking for ways to evolve their financial health along with the specialty’s ever-changing landscape. However, most clinics are sitting on a powerful revenue stream that traditional fertility billing services cannot fully capture: ancillary laboratory revenue.
Modern reproductive care is supported by diagnostic testing such as hormone panels and certain genetic tests. Many fertility practices are unaware that they can leverage the laboratory tests they are already ordering as an additional revenue stream. Phytest helps fertility clinics unlock this revenue through specialized fertility billing solutions that exclusively optimize ancillary laboratory reimbursements.
Why Lab Revenue Is Often Overlooked in Fertility Clinics
Fertility clinics already order several laboratory tests and panels, yet many are unaware of the full opportunity to capture revenue from these tests. There are a few reasons for this:
- Past failure or frustration: Some clinics have tried lab billing before but were met with confusing payer rejections, low reimbursements relative to the cost of testing, or internal staffing limitations.
- Lack of expertise: Internal billing staff and traditional fertility billing companies are typically focused on the global IVF cycle, surgical procedures, or office visits—not nuanced lab codes, modifiers, or payer specific billing requirements. The complexities of fertility laboratory billing can end up costing clinics more if it is done incorrectly.
- Assumption of non-reimbursable services: Clinics often assume it’s simpler to allow outsourced reference labs bill their patients, rather than dealing with insurance billing themselves. However, they may not realize we provide an opportunity for this process to be completely automated and managed by a team of lab reimbursement specialists.
With a specialized laboratory reimbursement partner and laboratory billing systems in place, this missed revenue can be captured reliably, seamlessly, and profitably.
Obtaining New Revenue From Fertility Laboratory Testing
Fertility clinics commonly order a range of lab tests, and many of them are eligible for insurance reimbursement when claims are filed properly and timely. With the correct CPT codes, documentation, and adherence to payer rules, these tests can contribute significantly to clinic revenue. Here are just a few examples:
- Hormonal profiles and thyroid panels
- Infectious disease screening:
- HIV
- Hepatitis B & C
- Rubella
- Varicella
- Carrier screening & genetic tests:
- Cystic fibrosis
- Spinal muscular atrophy (SMA)
- Fragile X
- Ashkenazi Jewish panel
Navigating fertility billing guidelines for these tests is where many traditional medical billing companies run into problems. Requirements vary based on payer, region, and even diagnosis codes. That’s why true experience in billing for laboratory claims, such as genetic fertility tests, is essential.
The Unique Challenges of Fertility Laboratory Billing
Certain fertility tests, such as carrier screens, come with unique clinical and financial dynamics when it comes to proper claim filing. Unlike primary care or general OB/GYN, fertility lab billing requires precise understanding of:
- Self-pay vs insurance: Clinics must juggle out-of-pocket IVF services with insurance-covered diagnostic workups.
- Pre-authorization and benefit verification: Payers may cover a lab test, but only with the right documentation.
- Documentation and coding: Fertility-specific diagnosis codes must justify testing based on payer policies.
- Denials and audits: Payers often scrutinize fertility claims, especially for high-cost or specialty genetic labs.
Add to that the constant evolution of fertility billing guidelines, and it’s easy to see why traditional fertility billing companies or practices themselves avoid chasing lab reimbursements. However, Phytest’s fertility billing services make these complexities become manageable and profitable.
Reducing Cost of Testing and Recovering More Payments
When tests are outsourced to third-party labs, clinics often have limited visibility into pricing structures or payer reimbursement. In many cases, they may not know whether a test is covered, how much will be billed to the patient, or whether any of that revenue could have been captured by the clinic itself. This lack of control not only affects revenue potential but also creates unpredictable financial experiences for patients.
Phytest supports fertility clinics by helping them regain control over this process. Clinics can cut the costs of the lab tests they are already ordering, improve margin, and make more informed decisions about test utilization. Through a combination of lab billing expertise, systems integration, and managed workflows, clinics can better manage the costs of tests they are ordering and the reimbursements for those tests.
Unlike general billing services that may prioritize higher-dollar procedural claims, our team is dedicated to optimizing laboratory revenue. From verifying patient benefits up front to submitting clean claims and proactive follow-up, our infrastructure reduces delays and minimizes denials.
By combining these strategies, fertility clinics can reduce the cost of testing and improve their patients’ experience with more affordable laboratory test options and dedicated patient support. The result is a more sustainable financial model that supports both operational goals and patient satisfaction.
Optimize Revenue with Fertility Lab Billing Solutions
Fertility clinics rely on diagnostic ancillary services to drive quality of care and create the best treatment plan for patients. Many fertility practices are unaware of the revenue opportunity their laboratory testing volume presents when exploring new strategies to improve the practice’s profitability.
Generating ancillary laboratory revenue is a specialized area of medical billing that most fertility billing companies are not equipped to handle. The complexities of fertility billing guidelines and evolving genetic testing requirements in the carrier screening space present many hurdles for successfully capturing reimbursement from fertility lab tests. Our company has worked with physician practices for over 27 years to exclusively help providers capture ancillary lab revenue.
By leveraging Phytest’s fertility billing services, fertility clinics can generate a new revenue stream that requires no additional administrative burdens and no upfront investment. Let us help your clinic unlock the full potential of laboratory tests your practice is already utilizing.
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